Abstract
Following non-anatomical resection of lung parenchyma with a Nd:YAG laser, a coagulated surface remains. As ventilation starts, air leakage may occur in this area. The aim of the present study was to investigate, whether additional coagulation either before or after ventilation has an additional sealing effect. Freshly slaughtered porcine heart-lung blocks were prepared. The trachea was connected to a ventilator. Using a Nd:YAG laser (wavelength: 1320 nm, power: 60 W), round lesions (1.5 cm in diameter) with a depth of 1.5 cm were applied to the lung using an 800-μm laser fiber (5 s per lesion). Group 1 (n = 12) was control. Additional coagulation was performed in group 2 (n = 12) without and in group 3 (n = 12) with ventilation restarted. Air leakage (ml) from the lesions was measured. The thickness of each coagulation layer was determined on histological slices. Differences between individual groups were analyzed by one-way ANOVA (significance p < 0.05). After resection, 26.2 ± 2.7 ml of air emerged from the lesions per single respiration in group 1. Air loss in group 2 was 24.6 ± 2.5 ml (p = 0.07) and in group 3 23.7 ± 1.8 ml (p = 0.0098). In comparison to groups 1 and 2 thickness of the coagulation layers in group 3 was significantly increased. After non-anatomical porcine lung resection with a Nd:YAG laser, additional coagulation of the ventilated resection area can reduce air leakage.
Highlights
Lung metastases are often removed non-anatomically using a Nd:YAG laser [1, 2], whereas pulmonary metastases are often removed via open access
Histological evaluation of the coagulation layer revealed an average thickness of 113.1 ± 1.4 μm
In all three groups the pattern of air leakage was observed in the form of continuous chains of bubbles
Summary
Lung metastases are often removed non-anatomically using a Nd:YAG laser [1, 2], whereas pulmonary metastases are often removed via open access (thoracotomy). During open surgery the entire lung is carefully palpated. In superficial resections [6] coagulation layers may well seal the lung parenchyma from air leaks. With increasing resection depth there is a growing risk of opening small bronchi or even segmental bronchi. The latter openings are clearly visible upon inspection of the resection surfaces and will lead to considerable air loss [6]. To avoid the risk of air leakage after laser resection in surgery, the majority of surgeons will routinely close resection sites by simple
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